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PUBLIC HEALTH SERVICES SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION <br /> 304 E. Weber Ave., Third Floor, Stockton, CA 95202 <br /> (209)468-3420 <br /> UNDERGROUND STORAGE TANK(UST) PROGRAM INSPECTION REPORT <br /> Facility Name <br /> Facility Address O 1� t vt <br /> Facilty Contact Title Phone No. � I <br /> Program ID# Number�of ST s) <br /> UST#/Product <br /> Overfill Prevention:Audible and Visual Mechanical V <br /> Piping system: Gravity Pressure Suction <br /> Monitoring system * '( 1✓ -3S 0 <br /> Automatic pump shutdown satisfies CCR2636 (g): Yes No k - <br /> VIOLATION(S) <br /> The above facility is not in compliance with the following section(s) of Health& Safety Code <br /> (HSC) and/or California Code of Regulations (CCR): <br /> 1 HSC 25284 Permit to operate <br /> 2 HSC 25292.3 Upgrade compliance certificate/sticker <br /> 3 CCR 2711(b) &(c) Current State Form A&B <br /> 4 HSC 25292.2 Certification of financial responsibility and letter from chief financial <br /> officer <br /> 5 CCR 2630 (d) Continuous monitoring system for UST system <br /> 6CR 2636 (c)(1) All releases in secondary piping flow to a collection sump <br /> 7 V CCR 2636(a) Secondary containment for piping is waterproof <br /> 8 CCR 2636 (f)(2) Automatic line leak detector(s) <br /> 9 CCR 2636 (f)(1) Continuous monitoring system for underground piping <br /> 10 CCA 2632 (c)(2) Continuous monitoring system for UST <br /> 11 HSC 25291(a)(2) Secondary containment for UST is tight <br /> 12 CCR 2636(f)(1) Continuous monitoring system for dispenser system <br /> 13 CCR 2635 (b)(1) Spill container <br /> 14 CCR 2635 (b)(2) Overfill prevention system <br /> 15 CCR 2631 (a) Primary containment is product-tight <br /> 16 HSC 25292.1 UST system is operated to prevent unauthorized release <br /> 17 CCR 2650 Recording/reporting unauthorized release <br /> 18 CCR 2632 (d) Monitoring and response plan <br /> 19 CCR 2712 (i) Monitoring and response plan is on site <br /> 20 CCR 2712 (b) Maintenance and monitoring records <br /> 21 CCR 2636 (f)(4) Annual line tightness test <br /> 22 CCR 2630(d) Annual line leak detector test <br /> 23 CCR 2630 (d) Annual monitoring certification <br /> 24 CCR 2643 (d) Daily monitoring of suction piping that is not continuously <br /> monitored <br /> PHS 260(8/04/00) 1 of— <br />